Heavy Drinking: The Untreated American Epidemic
It's Time for Safe, Private and Affordable Treatment that Works
Heavy Drinking is a “Public Health Crisis” in America. — JAMA Psychiatry
• One in four (26 percent) U.S. adults binge drink. Seven percent of U.S. adults — 14.6 million people — binge drink five or more days in a single month.[i] Binge drinking is defined as consuming five or more alcoholic drinks for men or four or more for women on the same occasion.[ii]
• Sixteen million people in the U.S. suffer from alcohol use disorder (AUD),[iii] which means that they experience compulsive alcohol use, loss of control and a negative emotional state when not drinking.
• The number of adults who engage in extremely high-risk drinking behaviors, including drinking at two or three times the “binge” threshold, has increased in the past decade.[iv] The increase in high-risk drinking is especially dramatic among older adults (≥ 65), racial/ethnic minorities and women.[v]
The impact of heavy drinking — on people, on families, on the workforce — is far-reaching.
• More than 10 percent of children in the U.S. live with a parent who struggles with drinking.[viii]
• High-risk drinking costs the U.S. economy $81.5 billion in losses to workplace productivity each year.[ix]
• Heavy drinking — itself one of the costliest chronic diseases in the United States — is a contributor to many of the other costliest[x] and most devastating chronic diseases, including cardiovascular disease, diabetes, depression, breast cancer and other cancers.
• Excessive alcohol consumption is the third leading preventable cause of death in the United States.[xi]
High cost, social stigma, and inaccessible, rigid treatment models keep people from the help they need.
• Ninety percent of people in need of treatment never receive any help.[xii]
• People in need of treatment, but not accessing it, cite high costs, ineffectiveness, personal or professional stigma and travel as major barriers to treatment. Contrary to the pervasive “denial” trope, only one-third say they are not interested in treatment.[xiii]
• At least 74 percent of rehabs use a 12-step model,[xiv] where total lifelong abstinence is the barometer of success. The first 12-step program, AA, was developed in 1935, in the immediate wake of prohibition.
Effective alternatives to traditional rehab exist and they can safely be delivered remotely.
• Individual needs vary, but most people can safely and successfully cut back or quit drinking from the comfort of home.
• Approaches to treatment that allow for people to moderate their drinking are at least as effective as approaches with a singular goal of abstinence.[xv]
• Offering people the choice to quit drinking or cut back has been shown to improve success rates of treatment.[xvi]
• Several medications can help people cut back their drinking; in fact, three oral medications are approved by U.S. Food and Drug Administration (FDA) specifically for treating alcohol use disorders.[xvii]
• Pairing outpatient cognitive behavioral therapy with appropriate medication has been shown to increase the effectiveness of treatment.[xviii]
• Behavioral therapy delivered by telephone or video has been demonstrated to be safe and effective.[xix]
• It takes most people up to a year to change a behavior pattern.[xx]
• Symptom recurrence rates for substance use disorders are comparable with those among other medical conditions, such as diabetes, hypertension and asthma.[xxi]
[iv] Hingson, R.W., et al. (2017). “Drinking Beyond the Binge Threshold: Predictors, Consequences, and Changes in the U.S.” American Journal of Preventive Medicine, 52(6), 717-727
[v] Grant, 2017.
[vii] CDC — Centers for Disease Control and Prevention. (2012, accessed 2017, May 12). "Vital Signs: Binge Drinking Prevalence, Frequency and Intensity Among Adults – United States, 2010." Morbidity and Mortality Weekly Report, 60(01), 14-19.
[ix] Sacks, J.J., et al. (2015). “2010 National and State Costs of Excessive Alcohol Consumption.” American Journal of Preventive Medicine, 49(5), 73-9.
[xi] Mokdad, A.H. et al. (2004). “Actual causes of death in the United States 2000.” JAMA: Journal of the American Medical Association 291(10):1238–1245 [Published erratum in: JAMA 293(3):293–294, 298].
[xii] SAMHSA, 2014 — Results.
[xiii] SAMHSA, 2015.
[xv] Marlatt, G.A. & Witkiewitz, K. (2002). “Harm Reduction Approaches to Alcohol Use: Health Promotion, Prevention and Treatment.” Addictive Behaviors, 27(6), 867-86.
[xvi] van Amsterdam J. (2013). "Reduced-risk drinking as a viable treatment goal in problematic alcohol use and alcohol dependence." The Journal of Psychopharmacology, (27), 987-997.
[xviii] Anton, R.F., et al. (1999). “Naltrexone and Cognitive Behavioral Therapy for the Treatment of Outpatient Alcoholics: Results of a Placebo-controlled Trial.” American Journal of Psychiatry, 156(11), 1758-64.
[xix] Bashshur, R. L., et al. (2016). “The Empirical Evidence for Telemedicine Interventions in Mental Disorders.” Telemedicine Journal and e-Health, 22(2): 87-113.
[xx] Lally, P., et al. (2009). “How are Habits Formed: Modelling Habit Formation in the Real World.” European Journal of Social Psychology, 40: 998-1009.